Maternal morbidity and near miss associated with maternal age: the innovative approach of the 2006 Brazilian demographic health survey

OBJECTIVE: To study the prevalence of potentially life-threatening maternal conditions and near miss in Brazil according to maternal age. METHODS: A secondary analysis of the 2006 Brazilian demographic health survey database using a validated questionnaire to evaluate maternal morbidity with a focus on age extremes. The study included 5,025 women with at least 1 live birth in the 5-year reference period preceding their interviews. Three age range periods were used: 15-19 years (younger age), 20-34 years (control), and 35-49 years (advanced maternal age). According to a pragmatic definition, any woman reporting eclampsia, hysterectomy, blood transfusion, or admission to the intensive care unit during her pregnancy/childbirth was considered a near-miss case. The associations between age and severe maternal morbidity were further assessed. RESULTS: For the 6,833 reported pregnancies, 73.7% of the women were 20-34 years old, 17.9% were of advanced maternal age, and only 8.4% were of younger age. More than 22% of the women had at least one of the complications appraised, and blood transfusion, which was more prevalent among the controls, was the only variable with a significant difference among the age groups. The overall rate of maternal near miss was 21.1 per 1000 live births. There was a trend of higher maternal near miss with increasing age. The only significant risk factor identified for maternal near miss was a lower literacy level among older women. CONCLUSIONS: There is a trend towards worse results with increasing age. The investigation of the determinants of maternal near miss at the community level using an innovative approach through a demographic health survey is an example suggested for under-resourced settings. .

Prevalence and risk factors for penile lesions/anomalies in a cohort of Brazilian men ≥ 40 years of age

Purpose To report the prevalence and risk factors of penile lesions/anomalies in a Metropolitan Brazilian city. Materials and Methods All participants undergoing prostate cancer screening in the city of Curitiba were systematically examined to identify penile lesions including cutaneous mycosis, sexually transmitted diseases, penile cancer, meatal stenosis, hypospadias, and Peyronie's disease. Outcomes of interest included the prevalence and the relative risk and 95% confidence intervals of the lesions/anomalies according to age, school level, race, personal history of diabetes, arterial hypertension, nonspecific urethritis, and vasectomy. Results Balanoposthitis occurred in 11.8% of all participants, with an increased risk in those with diabetes (RR = 1.73), or past history of nonspecific urethritis (RR = 1.58); tinea of the penis was present in 0.2%; condyloma acuminata in 0.5%; herpes virus infection in 0.4%; urethral discharge in 0.2%; genital vitiligo in 0.7%, with an increased prevalence in non-white men (RR = 4.43), and in subjects with lower school level (RR = 7.24); phimosis in 0.5%, with a nearly 7-fold increased risk in diabetics; lichen sclerosus in 0.3%; stenosis of the external urethral meatus in 0.7%, with a higher prevalence in subjects with lichen sclerosus (RR = 214.9), and in those older than 60 years of age (RR = 3.57); hypospadia in 0.6%; fibrosis suggestive of Peyronie's disease in 0.9%, especially in men older than 60 years (RR = 4.59) and with diabetes (RR = 3.91); and penile cancer in 0.06%. Conclusion We estimated the prevalence and risk factors of commonly seen penile diseases in an adult cohort of Brazilian men. .

The significance of biological, environmental, and social risk factors for prostate cancer in a cohort study in Brazil

To evaluate the significance of several risk factors for prostate cancer in a cohort of Brazilian men.

Subjects and methods: Men ≥ 40 years-old participating in a prostate cancer screening program between December 2006 and April 2011 in the city of Curitiba, Brazil, were evaluated to determine the prevalence, relative risk (RR) and 95% CI of prostate cancer according to age, race, ethnicity, family history of prostate cancer, educational level, and history of vasectomy, increased blood pressure, diabetes mellitus, and urethritis.

In 2121 men included in this study, prostate cancer prevalence was 0.6% for men between 40-49 years versus 2.0% (adjusted RR = 2.58), 7.7% (adjusted RR = 5.76), and 8.4% (adjusted RR = 4.88) for men 50-59 years, 60-69 years, and ≥ 70 years, respectively (p < 0.05 to all). The prevalence of cancer was 5.1% in blacks versus 3.3% in whites (adjusted RR = 1.56, p > 0.05); 6.1% in African descendants, in comparison to 3.0% in non-African descendants (adjusted RR = 3.17, p < 0.05); 5.1% in men with a positive family history, compared to 2.5% in those with no family history (adjusted RR = 1.55, p > 0.05); and 4.8% in participants with incomplete elementary school level or lower, compared to 2.2% in men with complete elementary school level or higher education (adjusted RR = 1.85, p > 0.05). Men with/without history of vasectomy, increased blood pressure, diabetes, and urethritis had a prostate cancer prevalence of 0.8%/3.0% (adjusted RR = 0.23, p > 0.05), 3.8%/2.2% (adjusted RR = 1.16, p > 0.05), 3.7%/2.6% (adjusted RR = 1.39, p > 0.05), and 2.6%/2.6% (adjusted RR = 0.99, p > 0.05), respectively.

Risk factors associated with an increased prevalence of prostate cancer in this cohort ...

Prevalência da infecção por chlamydia trachomatis em parturientes jovens atendidas em uma maternidade pública / Prevalence of chlamydia trachomatis at pregnants admitted in the public health maternity

A bactéria Chlamydia trachomatis (CT) é um dos principais agentes responsáveis por desfechos desfavoráveis em parturientes acometidas por doenças sexualmente transmissíveis no Brasil. Está envolvida com parto prematuro, rotura prematura de membranas, gestação ectópica e aborto recorrente,bem como com conjuntivite e pneumonia no recém-nascido. A prevalência da infecção é variável conforme o método utilizado e a população em estudo.Objetivo: estimar a prevalência da infecção por CT em parturientes jovens, entre 18 e 24 anos, admitidas no pronto-atendimento da Maternidade Victor Ferreira do Amaral; caracterizar comportamentos de risco através da avaliação dos dados epidemiológicos; identificar os determinantes de infecção por CT na população estudada. Métodos: na etapa do trabalho realizada em Curitiba- PR, os objetivos englobaram a estimativa da prevalência da infecção por CT em parturientes jovens entre 18 e 24 anos admitidas no pronto-atendimento da Maternidade Victor Ferreira no Amaral do Departamento de Tocoginecologia da Universidade Federal do Paraná, que atende população de gestantes de baixo risco, bem como a caracterização do comportamento de risco para a infecção na população estudada. Esse estudo faz parte de uma pesquisa multicêntrica, de âmbito nacional, transversal, cuja coleta de dados foi realizada no período compreendido entre julho de 2009 e janeiro de 2010. Amostras de urina foram coletadas durante a internação e analisadas pelo método de PCR, para identificação da bactéria. Além disso, foi aplicado um questionário abrangendo dados socio demográficos, gineco-obstétricos e de comportamento de riscopara doenças sexualmente transmissíveis. Resultados: nos resultados obtidos, das 65 amostras de urina coletadas nesta maternidade, quatro mostraram-se positivas para CT, revelando uma prevalência de 6,15%. Fatores de risco para DST, como a presença de início da atividade sexual precoce, bem como a baixa idade, tiveram relação positiva com a infecção. Conclusão: a prevalência da infecção foi inferior à obtida em outras populações de gestantes por métodos que usaram a coleta endocervical; os fatores de risco foram a ausência de parceiro sexual fixo, baixa idade e concomitância com outras DST; apesquisa de CT em gestante é justificável e necessária.

Chlamydia trachomatis (CT) is one of the main agents related with adverse outcomes in pregnant women in Brazil. Is involved in prematurelabor, premature rupture of membranes, ectopic pregnancy and recurrent abortion, as well as conjunctivitis and pneumonia in the newborn. The prevalence of infection varies according to diagnosis method and target population. Objective: the goal from this study was to estimate the prevalence of CT infectionin young pregnant women, between 18 and 24 years, admitted in the emergency room of the Maternity Victor Ferreira do Amaral the Obstetric Low Risk Sector from Gynecology and Obstetrics Department; The characterization from risk behaviors by assessing epidemiological data to identify the determinants conditions for CT infection in this population was evaluated. Methods: this study is part of a multicenter study, nationwide, cross-sectionaldata collection was performed during the period between July 2009 and January 2010. Urine samples were collected during hospitalization and analyzedby PCR for identification of CT. In addition, a questionnaire was administered covering socio-demographic, obstetric and gynecological risk behavior for sexually transmitted diseases. Results: the results obtained from 65 urine samples collected in this interin analysis showed four subjects positives forCT, indicating a prevalence of 6.15%. Risk factors for STDs, such as the presence of early sexual activity and low age from the pregnant was positively associated with the infection. Conclusion: the prevalence of infection was 6.15%, lower than those obtained in other populations of pregnant women whoused methods for collecting endocervical. The risk factors found relating with CT were absence of sexual relationship with the same partner, younger age from the pregnant and presence of association with other STDs. The CT screening in pregnant women is justifiable in addition with an evaluation from the risk factors.